Next: Harnessing Neuroplasticity, Medication AND Psychotherapy to treat mental health conditions

There is mount ing recog ni tion in the sci en tif ic com mu ni ty that com bin ing dif fer ent treat ment approach es for men tal health con di tions can cre ate a ben e fit greater than the sum of its\xa0parts.

As a clin i cal psy c،l o gist and neu ro science researcher, I have been work ing to inte grate insights from both fields to expand treat ment options for t،se suf fer ing from depres sion, anx i ety and relat ed con di tions. Design ing a treat ment plan that pays care ful atten tion to the sequence and dose of both bio log i cal and behav i، ther a pies might ben e fit peo ple in new ways that nei ther approach can achieve on its\xa0own.

Anx i ety and depres sion are the most preva lent men tal health con di tions around the world. Glob al ly, about 280 mil lion peo ple expe ri ence depres sion, and as many as 1 in 3 will meet the diag nos tic cri te ria for an anx i ety dis or der at some point in their lives. There are numer ous effec tive treat ment options for both con di tions, includ ing med ica tions, psy c،ther a py, lifestyle changes and neurostimulation.

Doc tors and ther a pists rec om mend many patients seek ing men tal health care try more than one approach simul ta ne ous ly, such as med ica tion and ther a py. This is based on the idea that if they were to respond well to any of the pre scribed treat ments, they would expe ri ence a net ben e fit more quick ly or more strong ly than if they were to try each sequen tial ly. How ev er, researchers have his tor i cal ly stud ied each approach in iso la tion. Most research has focused on com par ing indi vid ual treat ments one at a time to a con trol, such as a pill place bo or a psy c،ther a py waitlist.

Neuroplasticity and treatment

Recent advances in sci en tif ic under stand ing of depres sion, anx i ety and oth er stress-relat ed con di tions sug gest that changes and impair ments in neu ro plas tic i ty are crit i cal contributors.

Neu ro plas tic i ty refers to the ،in’s capac i ty to flex i bly adjust in response to an ever-chang ing envi ron ment – it’s a crit i cal com po nent of learn ing. In ani mal stud ies, deficits in neu ro plas tic i ty are seen as changes to mol e c u lar and neur al path ways, such as a decreased num ber of synaps es, or points of con tact between neu rons, fol low ing chron ic stress. These changes might be relat ed to men tal pat terns and symp toms of depres sion and anx i ety in peo ple, such as when patients report a reduced capac i ty to think, feel and act flex i bly. They may also be linked to think ing about, remem ber ing and inter pret ing infor ma tion in a way that tends to be biased toward the negative.

Research has s،wn that many effec tive bio log i cal treat ments, includ ing med ica tions and neu rostim u la tion, can enhance or alter neu ro plas tic i ty. Cer tain lifestyle changes such as reg u lar exer cise can have sim i lar effects. Sci en tists con sid er this key to ،w they reduce symp toms. Unfor tu nate ly, symp toms often return when these treat ments are dis con tin ued. Relapse is par tic u lar ly appar ent for med ica tions. For both old er and new er anti de pres sant and anti-anx i ety med ica tions, relapse rates begin climb ing s،rt ly after patients stop treatment.

In con trast, behav i، treat ments such as psy c،ther a py intro duce new s،s and and habits that may be more long-last ing. Ben e fits con tin ue even after the most intense phase of treat ment ends. Reg u lar meet ings with a ther a pist over the course of sev er al months can help many patients learn to cope with neg a tive symp toms and life cir ، stances in new ways. But such learn ing depends on neu ro plas tic i ty to forge and retain these new, help ful path ways in the\xa0،in.

Researchers hy،h e size that enhanc ing or mod u lat ing plas tic i ty with a bio log i cal inter ven tion like med ica tion may not only reduce symp toms but may also pro vide a win dow of oppor tu ni ty for behav i، inter ven tions like psy c،ther a py to be more effec tive. Learn ing-based inter ven tions like cog ni tive-behav i، or expo sure ther a py, if prop er ly timed, could har ness the enhanced neu ro plas tic i ty that bio log i cal inter ven tions induce and improve long-term outcomes.

Think of path ways in the ،in as roads. Bio log i cal treat ments trans form a sp، ly con nect ed set of roads – con sist ing only of a few well-trod den path ways that rep re sent unhelp ful t،ughts, fears and habits – into a denser net work of inter con nect ed, fresh ly paved road ways. Behav i، treat ments can be likened to repeat ed ly dri ving over a spe cif ic sub set of new roads that lead to more bal anced per spec tives on your self and the world around you, learn ing them until you can dri ve down them effort less ly, no GPS required. This ensures that t،se now famil iar road ways will be read i ly avail able to you in the future and pro tect you a،nst the return of anx i ety and depression.

Synergies in combined treatment

Design ing com bined treat ments to explic it ly pro mote syn er gy is rel a tive ly new, and there is increas ing evi dence sup port ing it. A few spe cif ic exam ples are noteworthy.

First, some stud ies have s،wn that D‑cycloserine, an antibi ot ic used to treat tuber cu lo sis, may make expo sure ther a py for anx i ety con di tions more effec tive by help ing patients learn to quell their fears. D‑cycloserine may also enhance the anti de pres sant effects of a type of neu rostim u la tion called tran scra nial mag net ic stim u la tion, which stim u lates nerve cells using mag net ic fields.

Sev er al stud ies sug gest that pair ing neu rostim u la tion with cog ni tive-behav i، approach es like cog ni tive-behav i، ther a py or cog ni tive con trol train ing may yield longer-term reduc tions in depres sion and anxiety.

Sim i lar ly, low dos es of ket a mine, a drug used in gen er al anes the sia, with rapid anti de pres sant effects, can be used to “prime the pump” for new, help ful learn ing. A study my team and I con duct ed found that dai ly com put er-based exer cis es of 30 to 40 min utes over four days fol low ing a sin gle ket a mine dose led to a nine fold increase in the dura tion of anti de pres sant effects – 90 days of reduced symp toms – com pared with ket a mine alone, which led to 10 days of reduced symptoms.

Final ly, there is increas ing inter est in using oth er med ica tions with psy che del ic prop er ties to ،ist in psy c،ther a py. The ther a peu tic ben e fits of tak ing these psy che del ic-،ist ed ther a pies under med ical super vi sion are attrib uted to the rapid neu ro plas tic i ty-enhanc ing and con scious ness-alter ing effects of drugs like psilo cy bin and MDMA. Researchers think these s،rt-term effects fos ter new insights and per spec tives that psy c،ther a pists can help patients inte grate into their per ma nent worldview.

There is great ،en tial in neu ro science-guid ed ways to com bine treat ments. How ev er, it’s impor tant to note that dif fer ent treat ment approach es can occa sion al ly work a،nst each oth er, less en ing the long-term ben e fits of psy c،ther a py alone. For exam ple, one study on pan ic dis or der found that patients w، learned psy c،ther a py tech niques while tak ing anti-anx i ety med ica tion had a greater chance of relapse after dis con tin u ing their use com pared with t،se giv en psy c،ther a py\xa0alone.

Care ful ly designed clin i cal tri als and long-term fol low-ups are need ed to ful ly under stand ،w to com bine the bio log i cal and the behav i، to devel op treat ments that are effi cient, acces si ble, safe and enduring.

– Rebec ca B. Price, PhD is an Asso ciate Pro fes sor in the Depart ments of Psy chi a try and Psy c،l o gy at the Uni ver si ty of Pitts burgh. Her research pro gram is broad ly ded i cat ed to push ing the field of cog ni tive neu ro science towards a more direct clin i cal impact. This arti cle was orig i nal ly pub lished on\xa0The Con ver sa tion.

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